The latest tempest over a dramatic drug price hike riles two powerful senators — who can’t actually do anything about it

First Nostrum CEO Nirmal Mulye caught the attention of FDA commissioner Scott Gottlieb when he jacked up the price of an old antibiotic from $474.75 to $2,392 last month. Now he has a pair of angry US senators on the warpath over his controversial, Martin Shkreli-like comments about the “moral requirement” of earning money for his investors and comparing the move to pricing art.

Nirmal Mulye

Coming in from opposite sides of the aisle, Claire McCaskill and Susan Collins let it be known that the original article from the Financial Times that got the show started had incensed them.

Susan Collins

“In the pharmaceutical industry — as opposed to the luxury art market — pricing decisions can have a devastating impact on patients and their families that can literally amount to a matter of life and death,” they noted in a letter to the CEO. The senators went on to demand information on the product and a description of the market conditions that could spark any further price rise.

Claire McCaskill

The furor over the little company’s gambit is reminiscent of the old Turing move on daraprim cited by the senators, who also tried to hold Shkreli accountable. Shkreli ended up taking the 5th when hauled in front of lawmakers, then wound up in prison on his conviction for defrauding his old hedge fund investors. But Congress had no power to do anything about the actual price of daraprim, and don’t here either.

At the end of the day, though, Gottlieb may have addressed the hubbub best by noting that there are others out there selling this therapy and there’s no shortage of it either.

2/2 There are other suppliers of this product and, by its own admission in @FT, the company in question isn’t actively marketing their formulation. Their excessive price, detached from market principles, exists only on a list and should remain there in a competitive marketplace

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There is a solution to this and essentially other identical scenarios of prices, even generics, that are way out of line. We are supposed to be living in a capitalistic society where open market and competition between "sellers" is encouraged. Yet that is total hogwash. We do not allow drugs from other countries into our pristine USA market. Why? They may be inferior in quality, or contaminated with heavy metals or even with other pharmacologic agents. OK. Then create a NEW industry that objectively assesses foreign drugs and/or devices for quality control and give the OK on those passing with flying colors and identify those that do not meet the standards of quality and/or quantity. Employ thousands of Americans in a job that can positively affect the welfare of millions of Americans. Years ago, some of my patients living in Southern California brought in ketoconazole purchased in Mexico. They had the same drug company label but of course the literature about the drug was in Spanish. The cost was 1/5 of the Mexican version vs the US version. Serum levels obtained with the Mexican version were equivalent and in some cases higher than those obtained using the American ketoconazole. But firm this approach by an organization that investigates standards, as does the IFOS (Independent Fish Oil Standard) organization in Canada. That would be a prototype to solve the problem. Instead of $30 per pill for a generic, the price would come down to competition with foreign distributors that believe that everyone is entitled to a profit but no one is entitled to "rape" the patient financially. Here's your solution. Stephen B. Strum, MD, FACP. In medical practice for over 45 years.